Annzetta'S Therapeutic Home for Boys, LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

ANNZETTA'S THERAPEUTIC HOME FOR BOYS, LLC

Practice address

1834 Buckner St
Petersburg, VA 23805-1705

Phone

(804) 863-2661

NPI assigned

Sep 27, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mary Emma Harris

Title

Office Clerk

Phone

(804) 861-5182

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193270400000",
    "number": "1063609659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1834 BUCKNER ST",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238051705",
            "telephone_number": "804-863-2661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1834 BUCKNER ST",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238051705",
            "telephone_number": "804-863-2661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANNZETTA'S THERAPEUTIC HOME FOR BOYS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-27",
        "last_updated": "2007-10-25",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "EMMA",
        "authorized_official_title_or_position": "OFFICE CLERK",
        "authorized_official_telephone_number": "804-861-5182"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Illness Community Based Residential Treatment Facility in Petersburg, VA
• Providers in Petersburg, VA by specialty
• Mental Illness Community Based Residential Treatment Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.